(Last Updated 8/23/2021)
Proving eligibility for Medicaid means checking every box to establish eligibility under the class of assistance the applicant seeks. The basic requirements are discussed in this chapter. Although financial eligibility criteria are a significant part of the planning and application process, they are discussed in later chapters.
- Section 1: Aged, Blind or Disabled
- Section 2: Categorial Eligibility
- Section 2.1: More on Citizenship
- Section 2.2: More on State of Residence
- Section 3: Medical Eligibility
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Social Security Announces 2.5 Percent Benefit Increase for 2025
On October 10, 2024, the Social Security Administration announced that Americans will increase a 2.5 percent cost of living increase in 2025. A fact sheet linked to the preset release shows that the monthly SSI rate for an individual will increase from $943 to $967. This COLA means the following (estimates) should apply beginning January […]
Medicaid’s payment of medical bills does not bar recovery from negligent party
When an injured party sues someone who negligently injured him or her, one form of damages the injured party may recover are medical expenses. However, can those expenses be recovered when they have been paid by someone else? In Bennett v. Haley, 132 Ga. App. 512 (1974), the Court said they can be recovered. The […]
Promissory Notes
When the Deficit Reduction Act of 2005 changed 42 U.S.C. § 1396p, new restrictions were imposed on promissory notes. Subsection (c)(1)(I) note provides that the purchase of a promissory notes is treated as a transfer subject to the penalty rules unless the note meets the following guidelines: (I) For purposes of this paragraph with respect […]
Refusal to Answer Medicaid’s Questions Justified Denial of Eligibility
In Lamle ex rel. Lamle v. Shropshire (W.D. Oklahoma 5/29/2024), a United States District Court upheld a denial of benefits where three Medicaid applicants refused to answer questions about promissory notes. Penelope Lamle, Marilyn Garrison and Maxine Houston each loaned money to others in exchange for a promissory note. Lamle and Garrison made loans to […]
How much protection does a Medicaid Asset Protection Trust really provide?
In Hammerberg v. Department of Human Servs. (Minn. Ct. App. 4/22/2024), the State made an estate recovery claim against what appears to have been an income only trust. Very little of the trust language appears in the decision, but the “trust instrument required the trustee to pay all income derived from the trust to the” […]
TennCare’s Medicaid Renewal Process was Illegal and Flawed
The Tennessee Justice Center and its legal partners brought a class action in the U.S. District Court for the Middle District of Tennessee alleging that TennCare’s for reevaluating eligibility was defective and failed to provide notice and an opportunity for a hearing. TJC alleged that TennCare’s policies and practices caused thousands of Tennesseans to lose […]
Georgia Medicaid Waiver Programs
Section 1115 of the Medicaid statute allows sates to test new or existing ways to deliver and pay for health care services in Medicaid and the Children’s Health Insurance Program (CHIP). The home health waivers are designed to meet the needs of people who prefer to get long-term care services and supports in their home […]
Locating Medicaid Law
Sometimes finding Medicaid law is tough, but we hope to give you resources here. Federal and state statutes, regulations and case law is available to subscribers of LEXIS and Westlaw. The federal statute, which is Title XIX of the Social Security Act, is at 42 U.S.C. § 1396 et seq. (the “Medicaid Act”). The federal […]
Medicaid Estate Recovery is Required
At common law there is no obligation to reimburse the government for financial support and services received while impoverished. When the Medicaid Act was enacted, Congress gave States the option of pursuing estate recovery and, until 1993, estate recovery remained optional. Now, within the parameters of the federal rule, States must pursue estate recovery (1) […]
Structure of the Medicaid Program
“Each participating State develops a plan containing reasonable standards . . . for determining eligibility for and the extent of medical assistance” within boundaries set by the Medicaid statute and the Secretary of Health and Human Services.” Wis. Dep’t of Health & Family Servs v. Blumer, 534 U.S. 473 (2002) (quoting Schweiker v. Gray Panthers, […]
